Trauma Care in the UK

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Dr Hardcastle

Although the structure of general surgical training in the UK is changing,
until recently prior to being appointed a trainee typically spent a minimum
of 8-9 years in clinical training (+ 2-3 years of research), rotating
through all the various specialties and electing to sub-specialise in the
last two to three years (whilst still taking call for general surgery,
including trauma), much like a 'fellowship'. The bad old days of 'open
ended' training are thankfully over! That said, the newly appointed
consultant is expected (indeed trained) to deal with abdominal emergency
surgery.

There is no formal requirement for critical / intensive care training
becuase these units are manned by dedicated 'intensivists', who are mostly
anaesthetists by training. However, critical care and emergency surgery
(including trauma) are vital parts of all surgical post-graduate
examinaitons, including the exit exam. Finally, it is compulsary to have
attended the 'Care of the critically ill surgical patient'  ( as well as the
ATLS) course and increasingly trainees rotate through critical care.

'Trauma Surgeons' per se do not exist in the UK, unlike the U.S or other
countries. Trauma patients arrive in the Accident and Emergency department,
and in the medium to large hospitals are attended to by a trauma team with
multi-specialty representation. The organisation of trauma care in general
can be better organised, as discussed in this thread.

The 'exposure' to penentrating truama is very low indeed and perhaps that's
the reason why you get so many requests for experience. Having expert
vascular on-call round the clock is a welcome development, which I have no
doubt improves outcome for the great majority of vascular patients.

 You make some 'interesting, comments in your e-mail, and paint a picture of
surgical training in the UK that I do not recognise, i.e., a newly appointed
consultant, unable to assess, manage or operate on surgical patients outside
of their narrow field !

There is increased emphasis on sub-specialistation, but that's a world wide
phenomenon in some guise or another- resources permitting? I am a bit
puzzled, what is your definition of a 'general surgeon'?

Best Wishes,
Saboor Khan
Coventry
UK




On Nov 26, 2007 4:47 AM, Hardcastle, Tim, Dr <tch at sun.ac.za> <tch at sun.ac.za>
wrote:

> Mike
>
> The other challenge that now exists in the UK is that there are less and
> less true "General Surgeons"; the majority of the "Trauma Surgeons" are
> mainly orthopaedic trained, while the GIT surgeons subspecialise even before
> they finish what we would know as residency. They qualify not as "General
> Surgeons", but as one of Breast-Endocrine / Upper GI / Colorectal or
> Hepato-biliary surgeons. Vascular is also seperate now. This leads to young
> consultant surgeons who have little idea of the overall patient and the care
> of trauma in particular. Add to this the lack of a formal ICU requirement in
> the post-grad training and you see where some of the deficiencies lie.
>
> For this reason we in South Africa are inundated with requests for people
> to do three month mini-trauma-fellowships to get some experience in General
> Trauma care.
>
> Regards
> Dr T C Hardcastle
> M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
> Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
> ATLS  instructor and DSTC Cape Town Course Director
> Intern program Coordinator: Surgery
> M.Med (Emergency Medicine) Executive Committee member
> Clinical Head (Director): Diana Princess of Wales Trauma Unit
> Division of Surgery (General) Room 4064
> Department of Surgical Sciences
> Tygerberg Hospital / University of Stellenbosch
> PO Box 19063
> Tygerberg 7505
> Western Cape
> South Africa
> e-mail: tch at sun.ac.za
> Cell: +27824681615
> Office: +27219389281 or 4911 pager 0302
>

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